There is an urgent need for improved and timely health and nutrition data. We developed and tested a smartphone application that caregivers from a pastoral population used to measure, record and ...submit high‐frequency and longitudinal health and nutrition information on themselves and their children. The data were assessed by comparing caregiver‐submitted measurements of mid–upper arm circumference (MUAC) to several benchmark data sets, including data collected by community health volunteers from the participating caregivers during the project period and data generated by interpreting photographs of MUAC measurements submitted by all participants. We found that the caregivers participated frequently and consistently over the 12‐month period of the project; most of them made several measurements and submissions in at least 48 of the 52 weeks of the project. The evaluation of data quality was sensitive to which data set was used as the benchmark, but the results indicate that the errors in the caregivers' submissions were similar to that of enumerators in other studies. We then compare the costs of this alternative approach to data collection through more conventional methods, concluding that conventional methods can be more cost‐effective for large socioeconomic surveys that value the breadth of the survey over the frequency of data, while the alternative we tested is favoured for those with objectives that are better met by high‐frequency observations of a smaller number of well‐defined outcomes.
Health and nutrition data are extremely expensive to collect among remote or otherwise difficult‐to‐reach populations. We find that caregivers in a remote setting can and will collect and submit high‐frequency health and nutrition information on themselves and their children using the Mbiotisho smartphone application. This low‐cost approach to data collection offers many exciting opportunities for those working on health and nutrition issues in remote settings.
Key messages
Caregivers, even those that are illiterate and with little smartphone experience, can and will use a simple icon‐based smartphone application to measure, record and submit health and nutrition information on themselves and their children consistently and at high frequency.
The errors in the data submitted by the caregivers are similar to those of data submitted by enumerators in similar settings.
The cost per data point of submissions by caregivers is much lower than data collected using conventional approaches but the simple icon‐ and audio‐based approach to data collection may not be appropriate for all data needs.
Abstract
Background
Household chicken production presents an opportunity to promote child nutrition, but the benefits might be offset by increased environmental contamination. Using household ...surveys, direct observations, and in-depth interviews with woman caregivers, we sought to describe the relationship between chicken management practices and household exposure to environmental contamination, and assess barriers to adopting improved husbandry practices.
Methods
First, we analyzed baseline data from 973 households raising chickens in the two interventions arms from the Agriculture-to-Nutrition (ATONU) study in Ethiopia to assess the relationship between animal management practices and environmental exposures. Second, we conducted six-hour direct observations of children’s environmental exposures in 18 households. Among these households, we analyzed in-depth interviews with child caregivers.
Results
Quantitative analyses showed that households raised approximately 11 chickens, had animal feces visible on the property 67% of the time, and children’s hands were visibly dirty 38% of the time. Households with more chickens had lower exposure to animal feces. Having a chicken coop increased the risk of observing animal feces on the property by 30%, but among those with a coop, having an enclosed coop reduced that risk by 83%. Coops that were enclosed, had fencing, and were located further from homes were associated with a reduced risk of observing animal feces and an increased likelihood of children having clean hands. Direct observations showed that chicken coops were often poorly designed or not used. On average, 3 to 5 chickens were inside homes at a time, and livestock and domestic animals were frequently inside of houses and interacting with young children. In-depth interviews revealed that protection of animals, maintenance of household cleanliness and health, type of chicken (local versus improved) and resource constraints influenced management decisions.
Conclusions
Improvements in chicken management practices could mitigate the exposure of household members to environmental contamination. Our findings highlight the need for training and resources to promote safe animal husbandry practices and optimal child health in nutrition-sensitive livestock projects.
Trial registration
Clinical trials number:
NCT03152227
; Retrospectively registered at ClinicalTrials.gov on May 12, 2012.
Sub-Saharan Africa is experiencing the coexistence of overnutrition, undernutrition and micronutrient deficiencies. Comprehensive programs and coherent public policies are required to address this ...problem. A study of food and nutrition security policies, strategies and programs in Ghana, Kenya and South Africa was conducted between February and July 2022 through desk reviews and key informant interviews. The aim was to generate evidence on the extent to which the policies, strategies and programs were nutrition-sensitive and add value to the scaling up of nutrition and food security. The assessment of the documents was based on the four dimensions of food security, and the Food and the Food and Agriculture Organization of the United Nations guidelines on nutrition-sensitive agriculture. A total of 48 policies, strategies and programs were reviewed. To ensure food availability, most reviewed documents tend to focus on food production and income generation, with limited attention on production and supply of diverse and nutrient-dense foods. Access to inputs, credit and land is targeted at smallholder farmers, without little sensitivity to women and youth engagement. Food access is promoted through improved market access by upgrading infrastructure and promoting social safety nets for vulnerable populations. However, information systems for agricultural marketing as well as labor- and time-saving technologies are lacking. Although nutrition education is widely promoted, especially for mothers and children, there is a gap in addressing the nutrition needs of adolescent girls. Regarding food stability, inadequate funding, poor leadership and governance and inadequate monitoring and evaluation systems are the main barriers to successful implementation of policies, strategies and programs. While efforts have been made to promote nutrition-sensitive options in the agriculture and food system value chains, the study identified several gaps that need to be addressed to ensure adequate food and nutrition security.
Chicken production in the context of nutrition-sensitive agriculture may benefit child nutrition in low-income settings.
This study evaluated effects of 1) a chicken production intervention African ...Chicken Genetic Gains (ACGG), and 2) the ACGG intervention with nutrition-sensitive behavior change communication (BCC) ACGG + Agriculture to Nutrition (ATONU), on child nutrition and health outcomes and hypothesized intermediaries.
Forty ACGG villages received 25 genetically improved chickens and basic husbandry guidance; of these, 20 ACGG + ATONU villages in addition received a nutrition-sensitive behavior change and homegardening intervention; 20 control clusters received no intervention. We assessed effects of the interventions on height-for-age z scores (HAZ), weight-for-agez scores (WAZ), and weight-for-heightzscores (WHZ) at 9 (midline) and 18 mo (endline) through unadjusted and adjusted ordinary least squares (OLS) regressions. We examined the interventions' effects on hypothesized intermediaries including egg production and consumption, dietary diversity, women's empowerment, income, child morbidities, anemia, and chicken management practices through OLS and log binomial models.
Data included 829 children aged 0–36 mo at baseline. ACGG + ATONU children had higher midline HAZ mean difference (MD): 0.28; 95% CI: 0.02, 0.54 than controls. The ACGG group had higher HAZ (MD: 0.28; 95% CI: 0.05, 0.50) and higher WAZ (MD: 0.18; 95% CI: 0.01, 0.36) at endline than controls; after adjusting for potential baseline imbalance, effects were similar but not statistically significant. At endline, differences in ACGG + ATONU children's HAZ and WAZ compared with controls were similar in magnitude to those of ACGG, but not statistically significant. There were no differences in anthropometry between the intervention groups. ACGG + ATONU children had higher dietary diversity and egg consumption than ACGG children at endline. Both interventions showed improvements in chicken management practices. The interventions did not increase anemia, diarrhea, fever, or vomiting, and the ACGG + ATONU group at midline showed reduced risk of fever.
A chicken production intervention with or without nutrition-sensitive BCC may have benefited child nutrition and did not increase morbidity.
This trial was registered at clinicaltrials.gov as NCT03152227.
JENSEN et al Jensen, Nathaniel; Watson Lepariyo; Alulu, Vincent ...
Maternal and child nutrition,
07/2023, Letnik:
19, Številka:
3
Journal Article
Recenzirano
Odprti dostop
There is an urgent need for improved and timely health and nutrition data. We developed and tested a smartphone application that caregivers from a pastoral population used to measure, record and ...submit high-frequency and longitudinal health and nutrition information on themselves and their children. The data were assessed by comparing caregiver-submitted measurements of mid–upper arm circumference (MUAC) to several benchmark data sets, including data collected by community health volunteers from the participating caregivers during the project period and data generated by interpreting photographs of MUAC measurements submitted by all participants. We found that the caregivers participated frequently and consistently over the 12-month period of the project; most of them made several measurements and submissions in at least 48 of the 52 weeks of the project. The evaluation of data quality was sensitive to which data set was used as the benchmark, but the results indicate that the errors in the caregivers' submissions were similar to that of enumerators in other studies. We then compare the costs of this alternative approach to data collection through more conventional methods, concluding that conventional methods can be more cost-effective for large socioeconomic surveys that value the breadth of the survey over the frequency of data, while the alternative we tested is favoured for those with objectives that are better met by high-frequency observations of a smaller number of well-defined outcomes.
In Ethiopia, women's dietary diversity is low, primarily due to poor food availability and access, both at home and market level. The present study aimed to describe market access using a new ...definition called market food diversity (MFD) and estimate the impact of MFD, crop and livestock diversity on dietary diversity among women enrolled in the Agriculture to Nutrition (ATONU) trial.
Baseline cross-sectional data collected from November 2016 to January 2017 were used for the analysis. Availability of foods in markets was assessed at the village level and categorized into nine food groups similar to the dietary diversity index for women. Bivariate and multivariate mixed-effects regression analyses were conducted, adjusted for clustering at the village level.
Chicken-producing farmers in rural Ethiopia.ParticipantsWomen (n 2117) aged 15-49 years.
Overall, less than 6 % of women met the minimum dietary diversity (≥5 food groups) and the most commonly consumed food groups were staples and legumes. Median MFD was 4 food groups (interquartile range: 2-8). Multivariate models indicated that women's dietary diversity differed by livestock diversity, food crop diversity and agroecology, with significant interaction effects between agroecology and MFD.
Women's dietary diversity is poor in Ethiopia. Local markets are variable in food availability across seasons and agroecological zones. The MFD indicator captures this variability, and women who have access to higher MFD in the highland agroecological zone have better dietary diversity. Thus, MFD has the potential to mitigate the effects of environment on women's dietary diversity.
In an effort to address undernutrition among women and children in rural areas of low‐income countries, nutrition‐sensitive agriculture (NSA) and behaviour change communication (BCC) projects heavily ...focus on women as an entry point to effect nutritional outcomes. There is limited evidence on the role of men's contribution in improving household diets. In this Agriculture to Nutrition trial (Clinicaltrials.gov identifier: NCT03152227), we explored associations between men's and women's nutritional knowledge on households', children's and women's dietary diversity. At the midline evaluation conducted in July 2017, FAO's nutrition knowledge questionnaire was administered to male and female partners in 1396 households. There was a high degree of agreement (88%) on knowledge about exclusive breastfeeding between parents; however, only 56–66% of the households had agreement when comparing knowledge of dietary sources of vitamin A or iron. Factor analysis of knowledge dimensions resulted in identifying two domains, namely, ‘dietary’ and ‘vitamin’ knowledge. Dietary knowledge had a larger effect on women's and children's dietary diversities than vitamin knowledge. Men's dietary knowledge had strong positive associations with households' dietary diversity scores (0.24, P value = 0.001), children's dietary diversity (0.19, P value = 0.008) and women's dietary diversity (0.18, P value < 0.001). Distance to markets and men's education levels modified the effects of nutrition knowledge on dietary diversity. While previous NSA and BCC interventions predominantly focused on uptake among women, there is a large gap and strong potential for men’s engagement in improving household nutrition. Interventions that expand the role of men in NSA may synergistically improve household nutrition outcomes.
Improving maternal and child nutrition in resource-poor settings requires effective use of limited resources, but priority-setting is constrained by limited information about program costs and ...impacts, especially for interventions designed to improve diet quality. This study utilized a mixed methods approach to identify, describe and estimate the potential costs and impacts on child dietary intake of 12 nutrition-sensitive programs in Ethiopia, Nigeria and India. These potential interventions included conditional livestock and cash transfers, media and education, complementary food processing and sales, household production and food pricing programs. Components and costs of each program were identified through a novel participatory process of expert regional consultation followed by validation and calibration from literature searches and comparison with actual budgets. Impacts on child diets were determined by estimating of the magnitude of economic mechanisms for dietary change, comprehensive reviews of evaluations and effectiveness for similar programs, and demographic data on each country. Across the 12 programs, total cost per child reached (net present value, purchasing power parity adjusted) ranged very widely: from 0.58 to 2650 USD/year among five programs in Ethiopia; 2.62 to 1919 USD/year among four programs in Nigeria; and 27 to 586 USD/year among three programs in India. When impacts were assessed, the largest dietary improvements were for iron and zinc intakes from a complementary food production program in Ethiopia (increases of 17.7 mg iron/child/day and 7.4 mg zinc/child/day), vitamin A intake from a household animal and horticulture production program in Nigeria (335 RAE/child/day), and animal protein intake from a complementary food processing program in Nigeria (20.0 g/child/day). These results add substantial value to the limited literature on the costs and dietary impacts of nutrition-sensitive interventions targeting children in resource-limited settings, informing policy discussions and serving as critical inputs to future cost-effectiveness analyses focusing on disease outcomes.
L’amélioration de la nutrition maternelle et infantile dans les milieux pauvres nécessite une utilisation efficace de ressources limitées, mais l’établissement des priorités est assujetti au manque d’informations sur les coûts et les impacts du programme, en particulier pour les interventions visant à améliorer la qualité du régime alimentaire. La présente étude a utilisé une approche de méthodes mixtes pour identifier, décrire et estimer les coûts et impacts potentiels de 12 programmes prenant la nutrition en compte sur l’apport alimentaire des enfants en Ethiopie, au Nigeria et en Inde. Ces interventions potentielles comprenaient des transferts conditionnels de bétail et d’argent, les médias et l’éducation, des activités complémentaires de transformation et de vente d’aliments, des programmes de production domestique et de tarification des denrées alimentaires. Les composantes et les coûts de chaque programme ont été identifiés grâce à un nouveau processus participatif de consultation régionale d’experts, suivi d’une validation et d’un étalonnage à partir des recherches documentaires et de la comparaison avec les budgets réels. Les impacts sur les régimes alimentaires des enfants ont été déterminés en estimant l’ampleur des mécanismes économiques favorables au changement de régime alimentaire, les examens complets des évaluations, l’efficacité des programmes similaires et les données démographiques sur chaque pays. Parmi les 12 programmes, le coût total par enfant atteint (valeur actuelle nette, parité ajustée du pouvoir d’achat) était très diversifié: de 0, 58 à 2650 USD/an pour les cinq programmes dÉthiopie; 2, 62 à 1919 USD/an pour les quatre programmes du Nigeria; et 27 à 586 USD/an pour les trois programmes de l’Inde. Lors de l’évaluation des impacts, on a observé que les apports en fer et en zinc ont été plus importants à la suite d’un programme complémentaire de production d’aliments en Éthiopie (augmentations de 17, 7mg fer/ enfant/jour et 7, 4mg zinc/enfant/jour), l’apport en vitamine A grâce à un programme de production animale et horticole domestique au Nigéria (335 RAE/enfant/jour) et l’apport en protéines animales provenant d’un programme complé- mentaire de transformation de denrées alimentaires au Nigéria (20,0 g/enfant/jour). Ces résultats ajoutent une valeur substantielle aux rares documents relatifs aux coûts et impacts diététiques des interventions nutritionnelles ciblant les enfants dans les milieux à ressources limitées, éclairent les débats politiques et sont des contributions essentielles aux futures analyses de rentabilité axées sur les effets de la maladie.
改善资源匮乏地区的孕产妇和儿童营养需要有效利用有限资 源, 但关于项目成本和影响的信息有限, 尤其是膳食质量改善 干预的信息有限, 制约了有限次序的选择。本研究采用混合方 法, 明确、描述并估计埃塞俄比亚、尼日利亚和印度12个营养 敏感型项目的潜在成本和对儿童膳食摄入的影响。研究涉及 的干预包括有条件牲畜和现金转移支付、媒体和教育、辅食 加工和销售、家庭生产和食品定价项目。通过专家地区咨询 的参与式过程确定各个项目的构成部分和成本, 根据文献检索 和对比实际成本进行验证和校准。估算膳食改变的经济机制 幅度, 全面回顾类似项目的评估和有效性以及各国人口数据, 从而确定对儿童膳食的影响。在这12个项目中, 每个儿童的总 成本（净现值、购买力平价）波动很大：埃塞俄比亚的五个 项目中从0.58美元/年到2650美元/年不等；尼日利亚的四个项 目为2.62美元/年到1919美元/年；印度三个项目为27美元/年 到586美元/年。在膳食影响方面, 最大的膳食改善是埃塞俄比 亚辅食生产项目改善的铁和锌摄入（每名儿童铁摄入增加 17.7mg/天, 锌摄入增加7.4mg/天）, 尼日利亚家庭动物和花卉 生产项目改善的维生素A摄入（每名儿童335RAE/天）, 以及 尼日利亚辅食加工项目改善的动物蛋白摄入（每名儿童20.0g/ 天）。上述结果为针对资源有限地区儿童的营养干预的成本 和膳食影响提供了丰富资料, 为政策讨论提供了证据, 可为未 来关注疾病结局的成本效果分析提供重要依据。
Mejorar la nutrición materna e infantil en entornos de escasos recursos requiere el uso efectivo de recursos limitados, pero el establecimiento de prioridades se ve limitado por la escasez de información sobre los costos e impactos del programa, especialmente para las intervenciones diseñadas para mejorar la calidad de la dieta. Este estudio utilizó un enfoque de métodos mixtos para identificar, describir y estimar los posibles costos e impactos en el consumo dietético infantil de 12 programas sensibles a la nutrición en Etiopía, Nigeria y la India. Estas intervenciones potenciales incluyeron transferencias condicionadas de ganado y efectivo, medios y educación, procesamiento y ventas de alimentos complementarios, programas de producción en el hogar y fijación de precios. Los componentes y los costos de cada programa se identificaron a través de un novedoso proceso participativo de consulta regional de expertos seguido de validación y calibración con búsquedas bibliográficas y comparación con los presupuestos reales. Los impactos en las dietas infantiles se determinaron mediante la estimación de la magnitud de los mecanismos económicos para el cambio en la dieta, revisiones exhaustivas de las evaluaciones y la efectividad de programas similares, y datos demográficos de cada país. Sobre los 12 programas, el costo total por niño alcanzado (valor presente neto, paridad del poder adquisitivo ajustado) varió ampliamente: de 0.58 a 2,650 USD/año entre cinco programas en Etiopía; 2.62 a 1,919 USD/año entre cuatro programas en Nigeria; y de 27 a 586 USD/año entre tres programas en India. Cuando se evaluaron los impactos, las mayores mejoras en la dieta fueron los consumos de hierro y zinc de un programa de producción de alimentos complementarios en Etiopía (aumentos de 17.7 mg hierro/niño/día y 7.4 mg zinc/niño/día), consumo de vitamina A de un animal doméstico y el programa de producción hortícola en Nigeria (335 RAE/niño/día), y el consumo de proteína animal de un programa de procesamiento complementario de alimentos en Nigeria (20.0g/niño/día). Estos resultados agregan un valor sustancial a la literatura limitada sobre los costos e impactos dietéticos de las intervenciones sensibles a la nutrición dirigidas a niños en entornos de recursos limitados, dando información para las discusiones de políticas y sirviendo como insumos críticos para futuros análisis de costoefectividad enfocados en los resultados de enfermedades.
Nutrition‐sensitive interventions to improve overall diet quality are increasingly needed to improve maternal and child health. This study demonstrates feasibility of a structured process to leverage ...local expertise in formulating programmes tailored for current circumstances in South Asia and Africa. We assembled 41 stakeholders in 2 regional workshops and followed a prespecified protocol to elicit programme designs listing the human and other resources required, the intervention's mechanism for impact on diets, target foods and nutrients, target populations, and contact information for partners needed to implement the desired programme. Via this protocol, participants described 48 distinct interventions, which we then compared against international recommendations and global goals. Local stakeholders' priorities focused on postharvest food systems to improve access to nutrient‐dense products (75% of the 48 programmes) and on production of animal sourced foods (58%), as well as education and social marketing (23%) and direct transfers to meet food needs (12.5%). Each programme included an average of 3.2 distinct elements aligned with those recommended by United Nations system agencies in the Framework for Action produced by the Second International Conference on Nutrition in 2014 and the Compendium of Actions for Nutrition developed for the Renewed Efforts Against Child Hunger initiative in 2016. Our results demonstrate that a participatory process can help local experts identify their own priorities for future investments, as a first step in a novel process of rigorous, transparent, and independent priority setting to improve diets among those at greatest risk of undernutrition.
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